Multi-functional medical device and related methods of use

ABSTRACT

A medical device including an elongate member having a proximal end, a distal end, and a lumen extending therebetween. The medical device may further include an end-effector disposed at the distal end of the elongate member. The end-effector may include a plurality of arms pivotally connected to one another, wherein each arm includes a tissue-contacting surface, a first portion of the tissue-contacting surface including a plurality of ridges configured to grasp tissue. Further, the tissue-contacting surface may include a channel oriented substantially parallel to a longitudinal axis of the medical device.

RELATED APPLICATION(S)

This application claims the benefit of priority of U.S. ProvisionalApplication No. 61/592,764 filed Jan. 31, 2012, which is incorporatedherein by reference in its entirety.

FIELD OF THE INVENTION

Embodiments of this disclosure relate generally to medical devices andprocedures. In particular, embodiments of the present disclosure relateto minimally invasive medical devices and procedures for manipulatingtissues from inside a patient's body.

BACKGROUND OF THE INVENTION

An endoscopic procedure typically involves indirect observation of asurgical field through an endoscope or similar device inserted throughan incision or a natural anatomical opening. The endoscope generallytakes the form of a long, flexible tube, including a light conductoralong with one or more channels for inserting medical devices.Endoscopes provide platforms for employing numerous tools asend-effectors, such as devices to grasp, clip, sever, and remove objectsfrom inside the body.

During surgical procedures, the need for precision end-effectors iscritical to ensure safe, effective, quick, and successful outcomes.Additionally, the time and effort required to exchange the requiredend-effectors during surgery could also be a critical factor during aprocedure. Multiple functionalities provided by a single end-effectormay reduce the use of multiple devices thereby reducing the invasivenessof the procedure. Thus, it would be desirable to use end-effectors withmultiple capabilities.

SUMMARY OF THE INVENTION

Embodiments of this disclosure relate generally to medical devices andprocedures. In particular, embodiments of the present disclosure relateto minimally-invasive medical devices and procedures for manipulatingtissues from inside a patient's body.

In one embodiment, a medical device may include an elongate memberhaving a proximal end, a distal end, and one or more lumens (foradditional functionality) extending therebetween. The medical device mayalso include an end-effector disposed at the distal end of the elongatemember, the end-effector may include plurality of arms, jaws, or othercomponents pivotally connected to one another. In addition, each arm mayinclude one or more tissue-contacting surfaces, a first portion of atissue-contacting surface including a plurality of ridges configured tograsp and retain tissue. Further, the tissue-contacting surface mayinclude a channel oriented substantially parallel to a longitudinal axisof the medical device.

In various embodiments, the medical device may include one or more ofthe following additional features: only one of a plurality of arms maybe configured to move; the entire tissue-contacting surface may includeridges; a second portion of the tissue-contacting surface may include amating surface having one or more teeth or ridges; a channel may extendin a direction that is substantially parallel to a longitudinal axis ofthe elongate member; a device may further comprise one or more cuttingelements configured to be advanced through the channel; a cuttingelement may be a cautery device; a suction and/or irrigation lumen; themedical device may further comprise one or more locking devices ormechanisms for selectively fixing a position of at least one of theplurality of arms; and a distalmost surface of at least one of theplurality of arms includes an atraumatic surface.

In another embodiment, a medical device may include an elongated memberhaving a proximal end, a distal end, and a lumen or shaft extendingtherebetween. The medical device may also include a control memberextending within a lumen of the elongated member, wherein the controlmember includes a distal end and a proximal end. The medical device mayalso include an end-effector disposed at a distal end of the controlmember, and the end-effector may include at least two arms connected atits proximal end to form a jaw-like structure, wherein each of the armsincludes a tissue-contacting-surface. The medical device may furtherinclude a plurality of retractable projections disposed on at least oneof the tissue-contacting surfaces.

In various embodiments, a medical device may include one or more of thefollowing additional features: only one of a plurality of arms may beconfigured to move; the medical device may further include one or morelocking devices for selectively fixing a position of at least one of theplurality of arms; the projections may be configured to selectivelyretract into respective openings on at least one of thetissue-contacting surfaces; both tissue-contacting surfaces may includea plurality of retractable projections; and at least one of the arms mayfurther include a substantially flat surface disposed proximate thetissue-contacting surface.

Further, in another embodiment, a medical device may include anelongated member having a proximal end, a distal end, and a lumenextending therebetween. The medical device may also include a controlmember extending within the lumen of the elongated member, the controlmember having a distal end and a proximal end. In addition, the medicaldevice may include an end-effector disposed at a distal end of thecontrol member, the end-effector including at least two arms connectedat its proximal end to form a jaw-like structure, wherein each of thearms includes a substantially flat inner surface disposed adjacent to aplurality of ridges.

In various embodiments, the medical device may include one or more ofthe following additional features: only one of a plurality of arms maybe configured to move; the medical device may further include a lockingdevice for selectively fixing a position of at least one of theplurality of arms; at least one of the plurality of ridges furtherincludes at least one selectively deployable projection; and thesubstantially flat inner surface may include a plurality ofsubstantially flat inner surfaces

Additional objects and advantages of the present disclosure will be setforth in part in the description, which follows, and in part will beobvious from the description, or may be learned by practice of thepresent disclosure. The objects and advantages of the present disclosurewill be realized and attained by means of the elements and combinationsparticularly pointed out in the appended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the invention, as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the disclosure andtogether with the description, serve to explain the principles of thedisclosure. Wherever possible, the same reference numbers will be usedthroughout the drawings to refer to the same or like parts.

FIGS. 1A-1D illustrate perspective views of a tissue grasper in an openconfiguration, according to some embodiments of the present disclosure.

FIG. 2 illustrates an arm of a tissue grasper, according to anembodiment of the present disclosure.

FIGS. 3A-3B illustrate a tissue grasper in an open configuration,according to further embodiments of the present disclosure.

FIG. 4 illustrates a tissue grasper in an open configuration, accordingto another embodiment of the present disclosure.

DESCRIPTION OF THE EMBODIMENTS

Reference will now be made in detail to embodiments of the disclosure,an example of which is illustrated in the accompanying drawings. Forconvenience, the term “tissue grasper” will be used throughout thisapplication.

Overview

The present disclosure provides a tissue grasper including two armsforming a jaw-like structure. The tissue grasper may be an end-effectorfor holding tissue and other target objects. The arms of theend-effector may be rotatably connected to one another to permit thearms to move between an open and closed configuration. A proximalportion of one or both arms may be operable connected to a controlmember. The control member extends through an elongated member extendingbetween the end-effector at its distal end to an end-effector actuatormeans (hereafter, controller) present at its proximal end. Articulatingthe controller actuates the end-effector to effectuate opening andclosing of the arms. The two arms may be differentiated as an “upper”and “lower” jaw. Various configurations of end-effector actuation,structure, and functions are described in the embodiments of thedisclosure. Further, as used in this disclosure, “distal” refers to aposition or direction further from the user, and “proximal” refers to aposition or direction opposite “distal” and closer to the user.

More particularly, the present disclosure provides a tissue-graspingdevice for securely holding and manipulating tissues. Manipulationincludes, but is not limited to, cutting, sectioning, stapling,clamping, cauterizing, grasping, holding, or scraping of tissue.Clamping as used in this disclosure means holding, grasping, and/orfastening tissues together. The various methods of manipulation aredescribed in detail hereafter.

Exemplary Embodiments

FIG. 1A depicts a tissue grasper 100 in an open configuration accordingto an embodiment of the present disclosure. The tissue grasper 100includes an end-effector 101 extending distally from an elongated member102. A control member (not shown) extends through the elongated member102 translating the movements from a controller or handle (not shown)present at the proximal end of the elongated member 102. The elongatemember 102 includes a clevis member 103 that is present at its distalend.

The end-effector 101 includes two jaws or arms, an upper arm 104A and alower arm 104B, (hereafter, arms 104) pivotally connected to each other.The jaws may be pivotably coupled to the clevis 103, for example, via apivot pin 113. A proximal end 105 of arms 104 may be rotatably connectedto one another to permit arms 104 to move between them. A control member(not shown) may be operably connected to the proximal end 105 of one orboth of arms 104, so that actuating the arms 104 at their proximal end105 translates into movement of the arms 104 at their distal end 106.While both arms 104 may be pivotable relative to one another, in someembodiments, one of the arms 104 may be fixed, and the other arm 104 maybe movable, so the control member actuates only the movable arm 104.

The cross section of the arms 104 may also vary on their proximal anddistal ends 105, 106. The distal end 106 of the arms 104 includes aninner surface 107, and an outer surface 108. As shown in FIG. 1, innersurface 107 is a tooth-type or ridge-like mating surface, therebyforming a substantial tissue contacting area to increase gripping andfriction applied to the tissue, to reduce the likelihood of the graspedtissue from slipping. In some embodiments, the tissue contacting areamay be substantially flat. At their distal ends 106, arms 104 may belinear, as shown in FIG. 1, but in alternate embodiments, the arms 104may also be curved. In some embodiments, inner surface 107 may includesurface roughening to enhance friction for improved tissue grasping. Inaddition, any suitable surface of arms 104 may include any desiredsurface roughening.

In additional embodiments, as shown in FIGS. 1B-1D the distal end 106 ofthe upper arm 104A may be varied in shapes and sizes. FIG. 1B depicts aspear headed tip 114, which may be used in skewering obstructing orunwanted tissues. The sharp end may also be used to tear open tissues toreach otherwise inaccessible areas within the body. The distal end 106may also be shaped as a curved beak 115 like structure as depicted inFIG. 1C. Alternatively, the distal end may be tapered laterally givingrise to a flattened edge 116 as shown in FIG. 1D. The flattened edge 116may also be beveled to prevent injury to the tissue. The modified distalends 114, 115 and 116 may also be used for scraping plaque or debrisadhered to the tissue. The modified distal ends 114, 115, 116 may alsobe used as a wedge to separate tissue layers or to single out vascularstructures from a bundle. The distal end modifications may be present onthe lower arm 104B or on both the arms 104. In some embodiments, spearheaded tip 114 may include a flat, elongated edge that may aid inscraping or cutting. For example, rather than tip 114, a distalmost endof one or more of arms 104 may be formed as a flat edge.

The inner surfaces 107 of the arms 104 comprise ridges 109 and grooves110 of suitable dimension. The cross section of the ridges 109 may be anangular slope, such as “V” shaped ridges 109. Alternatively, in otherembodiments, the cross section of the ridges 109 may be rectangular,semicircular, or a combination of shapes. The ridges 109 may also lieparallel to one another on any axis in a lateral plane. Additionally,the ridges 109 may also be intersecting each other. The grooves 110 mayalso intersect with one another at any desired angle. Further, theridges 109 may be present on at least one of the distal ends 106 of thearms 104. Alternatively, the ridges 109 may be present on both arms 104,seated within grooves 110 on the ridges 109. The ridges may vary inshape or dimension, and the inner surfaces 107 may provide correspondinggrooves 110 to accommodate the ridges 109. Further, ridges 109 may havedifferent heights, widths, and lengths.

The inner surface 107 on at least one of the arms 104 may also includebisection along the length of the arm 104. The bisection may take theform of a channel 111, allowing an element such as a blade to advance tothe distal end 106. The channel 111 may also be present on both theinner surfaces 107, and may be of similar or different dimensions. Thelumen and channel may consist of an opening for passage of exemplarytools through the device by the user. Such exemplary tools may include,but are not limited to, one or more needles, blades, or cautery tools.The channel may run parallel to the longitudinal axis, may be present atan angle, or may have a curve or bend.

The embodiment shown in FIGS. 1A-D also includes an advancing member,such as a cautery blade in the form of a cutter tool 112. In addition,the cutter tool 112 may be any other cautery tool, such as anelectrocautery blade, a coagulation forceps, suction cautery devices,laparoscopic electrodes, laser fibers, lithotripters, and electrodecautery tips, which may include ball-tip, needle, and extended or flatblade electrodes. Further, the embodiments of FIGS. 1A-D may include anysuitable suction and/or irrigation device. In some embodiments, theadvancing member may include one or more channels, having a desiredconfiguration, running at least partially along the length of theadvancing member. For example, the channel may run parallel to theadvancing member. Alternatively, the channel may be angled or curvedwith respect to the advancing member.

As shown in FIG. 1B, the cutter tool 112 may be a cautery blade, whichis present at the proximal side of the distal end of the arm. The cuttertool 112 may be connected to a control member (not shown), and may beactuated by articulating the controller present at the proximal end ofthe control member. If connecting cutter tool 112 to the existingcontroller proves inconvenient, then an additional control member may beprovided. The cutter tool 112 may be advanced or retracted along thelength of the inner surface 107, with the dimensions of the tool beingaccommodated within the channel 111 bisecting the inner surface 107.

Tissue or vessel excision may lead to blood loss and furthercomplications during surgery. The tissue grasper 100 with the integratedcutter tool 112 may allow for cauterizing tissue present within the arms104 of the tissue grasper 100, thereby preventing slippage of the endsof the cut tissue. This may especially be useful in the case of bloodvessels and ducts. In some embodiments, a cautery tool (e.g., anelectrocautery blade) may be able to operate cold for cutting. That is,energy may not be required for cutting of tissue. However, in somecases, energy may be applied either to improve cutting or to containbleeding through cauterization of tissue.

The cutter tool 112 may be replaced by a suction tool in someembodiments. The suction tool may be shaped similar to a Touhy needle,which can penetrate the grasped tissue and drain the fluids trappedwithin it. The suction tool may be in turn connected to a vacuum pump.In addition, the cutter tool 112 may be replaced by an irrigation toolfor connection to an irrigation pump. The irrigation tool may be used toflush, e.g., tissue or other bodily matter from the treatment site.

The tissue grasper 100 may also integrate a tissue stapling or fasteningmeans (not shown). Tissue stapling comprises a stapling element that maybe disposed on at least one of inner surfaces 107. In another embodiment(not shown), two interlocking pieces of a stapling means are disposed onthe two inner surfaces 107. When tissue is grasped between the open arms104, the staple may be inserted and secured in place by the forceprovided during the closure of the arms 104. The stapling driving andforming operation could also be achieved by the advancing forward, i.e.,proximal to distal, or by pulling rearward, i.e., distal to proximal, ofa staple driving mechanism.

The tissue grasper 100 may also include a clamping element (not shown),which may be a “U” shaped elongate structure whose ends may becompressed towards one another and locked to form a fastening or sealingstructure. In one embodiment, a clamp may be disposed between the distalends 106 of the arms 104, wherein the clamp ends are towards the distalend 106. When tissue is grasped between the open arms 104, the clamp maybe tightened and the ends secured in place by the force provided duringthe closure of the arms 104. Further modifications to the inner surface107 are hereafter provided in the additional embodiments of thisdisclosure.

The outer surface 108 of the distal end 106 may be of any suitable shapethat provides an atraumatic surface, such as beveled edges and roundedcorners, to soft tissue. If desired, the end-effector 101 can becompletely retracted into a protective sheath (not shown), and in oneembodiment, the end-effector 101 can be completely withdrawn into anendoscope or similar instrument (not shown). The retracted configurationcould prove useful for moving the unit through a patient's body lumensin preparation for use.

As described above, cauterization features may be incorporated by use ofan electrocautery blade. In this embodiment, the inner surface 107 isformed of insulated or non-conductive material, for example, ceramic,plastic or any other suitable material known in the art. In otherembodiments, the outer surface 108 may be made of any rigid material,such as metals, plastics, ceramics, or any other suitable material,which is biocompatible, and atraumatic to tissues. The outer surface 108may also be coated with radio opaque materials, such as metals.Alternatively, the plastic or ceramic components may be ingrained withmetal particulates to Improve radio visibility. Power may be supplied tothe electrocautery blade through an additional channel (not shown)provided in elongated member 102.

As best seen in FIG. 1, the inner surface 107 is oriented at an angle θrelative to the axis A-A′ of the elongated member 102. In thisembodiment, the inner surface 107 is at an angle θ, however, in otherembodiments, angle θ may be more or less than 90 degrees. Further,although angle θ is substantially the same in each arm 104, it should beappreciated that angle θ may be the same or different for one or morearms 104. Inner surface 107 engages and grasps the tissue segments thatare retained within the space between arms 104. To enhance the graspingof the tissue segments within the space, angle θ may be less than orequal to 90 degrees.

In additional embodiments, the distal end 106 of the upper arm 104A mayinclude a curved end. The end may be tapering in all directions leadingto a spear headed tip 114 as shown in FIG. 1B. The spear headed tip 114may be useful in skewering obstructing tissues. The spear headed tip 114may also be curved to form a beak like structure as shown in FIG. 1C.Alternatively, the distal end 106 may be tapered laterally giving riseto a flattened edge 116 as shown in FIG. 1D. The edge may also be bluntand beveled to prevent injury to the tissue. The modified distal ends114, 115, 116 may also be used for scraping plaque or debris adhered tothe tissue. The flattened edge 116 may also be used as a wedge toseparate tissue layers or to single out vascular structures from abundle. Any component or the Instrument as a whole may include a bipolarconstruction having areas of opposite polarity with insulation betweencomponents.

In another embodiment, as shown in FIG. 2, the inner surface 107 of theend-effector 101 may also include barb-like elements that can beadvanced or retracted. The barbed elements (hereafter, projections 202)may penetrate the tissue, to provide a better grip on slippery or densetissue.

The projections 202, formed as rigid protrusions or extensions, aredisposed on at least one of the inner surfaces 107. Alternatively, theprojections 202 may be made of flexible material, and may have hookedends to grab on to tissue. The projections 202 may also be an actuableelement that can be advanced (from below flush with inner surface 107)to the desired length for the required tissue engagement, retracted, orheld in position. The projections 202 may also be tubular structures,such as a Touhy needle like structure. The lumen on the tubularstructure may be connected to a drainage system or a vacuum suction todrain fluids from grasped tissue. The tubular structures may also injectantiseptic formulations or anesthetics to prevent sepsis and relievepain.

The inner surface 107, as shown in FIG. 2, also includes ridges 109 andgrooves 110, as explained in connection with the first embodiment. Theprojections 202 may be advanced through slots (not shown) on the innersurface 107. The projections 202 may be connected to a controller viasuitable control members (not shown). In some embodiments, theprojections 202 may be actuated with a wedge-like deployment meanswithin the end-effector, wherein distal movement of wedge pushes theprojections up. In case the inner surface 107 is ridged, the slots mayalso be present on the ridges 109 or in the grooves 110. In addition,the tissue grasper 100 as described in this embodiment, may also includethe variations described above in connection with the embodimentsdescribed in FIG. 1 for example, the projections 202 may be presentalong with a cutter tool 112.

FIG. 3A depicts a tissue grasper 100 according to another embodiment ofthe present disclosure. The inner surface 107, as shown in FIG. 3,includes ridges 109 and grooves 110, as explained in the previousembodiments. The inner surface 107 may also be partially ridged. Theridges 109 may be present at a proximal or distal region, oralternatively may be present on both the proximal and distal regions ofthe distal end 106 of the arm 104, and there may be a patch of regionalong the inner surface 107 that is free from any ridges 109 (“unridgedportion 302”) as shown in FIG. 38. The unridged portion 302 may includea non-slippery surface, which in turn may have a roughened surface toincrease friction. The multiple teeth and/or surface configurationscould be used for, as an example, grasping different tissue types,including, but not limited to, thick and dense tissue, thick and softtissue, and thin and light tissue. In addition, grasping other surgicaldevices such as needles or sutures.

The unridged portion 302 as shown FIGS. 3A-B may be used as an anvil tostrike, for example, a staple, a fastener, or a clip, through thegrasped tissue. Staples may be disposed on the inner surface 107 of theupper arm 104A. When the arms 104 move towards each other the staplesmay be forced into the tissue. The unridged portion 302 provides asurface where the free ends of the staples fold upon themselves tosecurely attach to the tissue. Similar mechanisms may also beimplemented in the embodiment as described by FIGS. 1A-1D, where as thecutting element 112 slices through the tissue the cut ends of the tissuemay be stapled simultaneously to prevent bleeding. The staples may bepresent on the axis parallel to the channel 111 such that the staples donot interfere with the movement of the cutting element 112.

A needle (not shown) may be disposed at the unridged portion 302 of thisembodiment, and the end-effector 101 used as a needle holder forsuturing. The unridged portion 302 may also be further used to hold thesuture during a surgical maneuver. The surface may also include anadhesive coating, depressions, or slots to accommodate a needle. Thesurface may also be made of materials such as fabric, plastic, rubber,ceramic, or metal. The present embodiment may further be used along withthe previous embodiments.

The ridges 109 as shown in the FIGS. 1-3 may not be uniform in shape anddimension. For example, as shown in FIG. 4, some of the ridges 109 maybe larger than the others. The slope of the ridges 109 may be differentfor each ridge. The ridges 109 may have a plateau on the top surface asshown in the FIGS. 1-3. Alternatively, the ridges 109 may have a sharpor blunt surface based on the texture and properties of the tissue to behandled. Ridges of various shapes, sizes, and orientations may coexiston the same inner surface 107.

The arms 104 may include holes 402 on their inner surface 107, whichextends to the outer surface 108. The holes 402 form a passage throughwhich fluids from the tissues may be squeezed out. The holes 402 on onearm may also line up with holes 402 on the opposite arm thereby a thoughhole may be formed. Needles, pins, fasteners or any instrument ofsuitable dimensions may be inserted through the holes 402. In someembodiments, arms 104 may be hollow having a channel that is connectedto a vacuum pump to assist in holding tissue.

Further, the arms 104 may also include a locking mechanism to fix themin a specific position. Grasped tissue may be held indefinitely withoutapplication of force to the control member by locking the arms 104 inposition. Locking means may include any suitable mechanism, such as snapfit, screw, or fastening means. The arms 104 may also include a magneticelement and may be locked by the magnetic attraction.

In alternate embodiments, the inner surface 107 may be detachable. Thearms 104 may include locking mechanisms to which the inner surface 107may be attached. Alternatively, the arms 104 may also be detachable fromthe elongate member 102.

The outer surface 108 of the arms 104 may comprise an atraumatic surfacewith beveled edges as shown in the various embodiments of thisdisclosure. Alternatively, the outer surface 108 may also includeabrasive elements, barbed projections, or tissue retracting arms.Additional modifications such as abrasive elements provide furthertissue manipulating capabilities such as scraping removing unwantedtissue growth, plaques, and deposits. Barbed projections on the outersurface 108 may attach to the tissues and may be used to remove debrisand sectioned tissues from narrow vessels. In some embodiments, notchesmay be cut into arms to assist in tissue grasping when arms 104 arepushed or pulled through tissue. The dimensions of the notches may vary,as desired. In addition, various alternatives of the notches may becontemplated without departing from the scope of the present disclosure.Retracting arms may prevent interference from surrounding tissue and mayaid the physician in manipulating sequestered tissues.

Other embodiments of the present disclosure will be apparent to thoseskilled in the art from consideration of the specification and practiceof the embodiments disclosed herein. It is intended that thespecification and examples be considered as exemplary only, with a truescope and spirit of the Invention being indicated by the followingclaims.

1-20. (canceled)
 21. A medical device comprising: an elongate memberhaving a proximal end and a distal end; an end-effector disposed at thedistal end of the elongate member, the end-effector including a firstarm and a second arm connected at a proximal end of the end-effector toform a jaw-like structure, each of the first and second arms includingan inner surface and an outer surface; wherein at least one of the firstarm or the second arm includes a plurality of ridges, each ridgeextending along the inner surface of the corresponding first arm orsecond arm in a direction substantially perpendicular to a longitudinalaxis of the medical device; and wherein at least one of the first arm orthe second arm defines an aperture extending from the inner surface tothe outer surface of the corresponding first arm or second arm.
 22. Themedical device of claim 21, wherein at least one of the first arm or thesecond arm defines a plurality of apertures.
 23. The medical device ofclaim 21, wherein each of the first arm and the second arm defines atleast one aperture.
 24. The medical device of claim 23, wherein theapertures of the first and second arms are aligned when the jaw-likestructure is closed.
 25. The medical device of claim 21, wherein each ofthe first and second arms includes a plurality of ridges.
 26. Themedical device of claim 25, wherein each of the first and second armsincludes a groove disposed between adjacent ridges of the plurality ofridges, and each ridge of the first arm is aligned with a correspondinggroove of the second arm when the jaw-like structure is closed.
 27. Themedical device of claim 21, wherein first arm or the second arm includesat least one ridge having a plateau on a top surface of the at least oneridge.
 28. The medical device of claim 21, wherein the first arm or thesecond arm includes at least one ridge having a sharp surface.
 29. Themedical device of claim 21, wherein the first arm pivots relative to thesecond arm.
 30. The medical device of claim 29, wherein the first armand the second arm are coupled to a clevis, and wherein the second armis fixed to the clevis and the first arm pivots relative to the secondarm.
 31. A medical device comprising: an elongate member having aproximal end and a distal end; an end-effector disposed at the distalend of the elongate member, the end-effector including a first arm and asecond arm pivotally connected to the first arm at a proximal end of theend-effector to form a jaw-like structure, each of the first and secondarms including an inner surface and an outer surface; wherein each ofthe first arm and the second arm defines a plurality of aperturesextending from the inner surface to the outer surface of thecorresponding first arm or second arm.
 32. The medical device of claim31, wherein each aperture of the plurality of apertures of the first armis aligned with an aperture of the plurality of apertures of the secondarm when the jaw-like structure is closed.
 33. The medical device ofclaim 31, wherein at least one of the first arm or the second armincludes a plurality of ridges, each ridge extending along the innersurface of the corresponding first arm or second arm in a directionsubstantially perpendicular to a longitudinal axis of the medical device34. The medical device of claim 33, wherein each of the first and secondarms includes a plurality of ridges.
 35. The medical device of claim 34,wherein the first arm and the second arm are coupled to a clevis at theproximal end of the end-effector.
 36. A medical device comprising: anelongate member having a proximal end and a distal end; and anend-effector disposed at the distal end of the elongate member, theend-effector including a first arm and a second arm pivotally connectedto each other at a proximal end of the end-effector to form a jaw-likestructure, wherein an inner surface of at least one of the first arm orthe second arm includes an unridged portion between two ridged portions,each ridged portion comprising a plurality of ridges, each ridgeextending along the inner surface in a direction substantiallyperpendicular to a longitudinal axis of the medical device.
 37. Themedical device of claim 36, wherein the first arm and the second arm arecoupled to a clevis at the proximal end of the end-effector.
 38. Themedical device of claim 36, wherein the unridged portion issubstantially flat.
 39. The medical device of claim 36, wherein each ofthe first and second arms includes at least one ridged portioncomprising a plurality of ridges.
 40. The medical device of claim 36,wherein each of the first and second arms includes an unridged portionbetween two ridged portions.